心脏瓣膜病病人营养风险筛查及营养支持与术后临床结局的相关性分析  

Association analysis of nutritional risk screen and nutrition therapy with postoperative complications in patients of valvular heart disease

作　　者：吴春涛[1] 刘苏[1] 唐闽[1] 李倩[1] 刘钰[1] 王凤安[2] 阎庆辉[2] WU Chun-tao;LIU Su;TANG Min;LI Qian;LIU Yu;WANG Feng-an;YAN Qing-hui(department of cardiac surgery, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, China;department of anorectal surgery, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, China)

机构地区：[1]河北医科大学第二医院心外科,河北石家庄050051 [2]河北医科大学第二医院普外三科,河北石家庄050051

出　　处：《肠外与肠内营养》2019年第2期104-108,共5页Parenteral & Enteral Nutrition

摘　　要：目的:观察心脏瓣膜病病人营养风险筛查及营养支持与术后临床结局的相关性。方法:收集病人的临床资料,包括性别、年龄、术前白蛋白,前白蛋白水平,筛查有无营养风险。观察病人营养风险的发生与心功能分级之间的关系。对存在营养风险的病人分成营养支持组和对照组,对术后第14天血清白蛋白(ALB),前白蛋白结果和机械通气时间、住ICU时间、引流管拔除时间、住院时间及肺部感染发生情况进行观察。结果:瓣膜病病人营养风险的发生率为30.05%,Spearman等级相关分析显示,心功能与营养风险有相关性(r=0.317,P <0.01),存在正相关关系。营养支持组与对照组比较,两组术后第14天ALB水平无显著性差异(P> 0.05),但术后第14天营养支持组前白蛋白水平高于对照组,两组差异有统计统计学意义(P <0.05);两组机械通气时间无显著性差异(P>0.05),但营养支持组住ICU时间、引流管拔除时间、平均住院时间明显短于对照组,差异有统计学意义(P <0.05);术后营养支持组肺部感染发生率低于对照组,差异有统计学意义(P <0.05)。结论:应用NRS 2002进行营养风险筛查,发现瓣膜病病人术前存在较高的营养风险;在围术期,对存在营养风险的病人加强营养支持治疗,明显降低术后并发症发生率,缩短住院时间和ICU停留时间,改善临床结局。Objective: To observe the associations between nutrition risk screen as well as nutrition support and postoperative clinical outcomes in patients with valvular heart disease. Methods: The clinical data of patients were collected, including gender, age, preoperative albumin(ALB) levels, pre-albumin levels, and nutrition risk screen. The associations between the occurrence of nutritional risk and cardiac function classification was observed. The patients with nutritional risk were divided into nutrition support group and the control group randomly. The serum ALB levels,prealbumin levels, mechanical ventilation days, ICU days, drainage tube free-days, hospital days and incidence of pulmonary infection were observed and collected after heart surgery. Results: The incidence of nutritional risk in patients with valvular disease was 30.05%. Correlation analysis showed that there was a positive correlation between cardiac dysfunction and nutritional risk(r = 0.317,P < 0.01).There was no statistical difference in serum ALB levels between the two groups(P > 0.05) on the 14 th day after surgery. The levels of prealbumin in the nutrition support group was significantly higher than that in the control group on the 14 th day after surgery(P < 0.05). There was no statistical difference in mechanical ventilation days between the two groups(P > 0.05). The ICU days, drainage tube free-days and the average length of hospital stay in the nutritionsupport group were significantly shorter than these of the control group,which reached the statistical difference(P < 0.05). The incidence of postoperative pulmonary infection in the nutrition support group was remarkably lower than that in the control group(P < 0.05). Conclusions: There was a high nutritional risk in patients with valvular disease before heart surgery screened by NRS 2002. Nutrition support, which was performed for patients with nutritional risk during perioperative period, could significantly reduce the incidence of postoperative complications, shorten the length of ICU a

关 键 词：瓣膜病 营养风险 营养支持治疗 临床结局 

分 类 号：R459.3[医药卫生—治疗学] R563.1[医药卫生—临床医学]